For decades, researchers and the community alike have awaited a 'silver-bullet' style drug to treat Alzheimer's disease, the major cause of dementia which accounts for over 50% of cases. Available medicines reduce symptom progression but do not alter progression of the disease. What the results of multiple trials and the cost of any treatments has highlighted is a more fundamental issue: even if we do find a therapeutic treatment, it won't proactively prevent future genrations from developing the disease.
In the absence of available disease-modifying drugs, a shift toward delaying onset and possible prevention of Alzheimer's disease has gained momentum, with modifiable risk factors accounting for up to a third of the population attributable risk for Alzheimer's disease.
Today, 22 July, is World Brain Day. In conjunction with the World Health Organization, the World Federation of Neurology has announced 'Brain Health and Prevention' as this year's theme.
The Centre for Healthy Brain Ageing (CHeBA) at UNSW Sydney leads the world's largest internet-based trial to attempt to prevent cognitive decline and dementia. The trial - Maintain Your Brain - recruited over 6000 participants aged 55-77 to target modifiable risk factors for dementia in general and Alzheimer's disease in particular. Led by internationally acclaimed expert in brain ageing, Professor Henry Brodaty AO, the trial tested whether improving lifestyle behaviours can slow cognitive decline and, in the longer term, delay the onset of dementia. The trial was innovative because all the interventions were online, making it relatively inexpensive to implement to the wider general population.
Research into prevention is a major priority for us.
CHeBA Co-Directors Professor Henry Brodaty and Professor Perminder Sachdev
"As dementia is primarily a disease of late-life, delaying the onset by targeting these modifiable risk factors can have a major impact on Alzheimer's disease rates.
"Postponing onset by even two years could reduce Alzheimer's disease prevalence by up to 20% and a 5-year delay could potentially halve the prevalence."
Dementia is the greatest cause of disability in Australians aged over 65 years, the second leading cause of mortality, and the highest in women.
It affects approximately 57 million people worldwide and by 2050, as the population ages, the prevalence of dementia is set to triple. Globally, it is a leading cause of disability with costs estimated to be more than 800 billion dollars and over the next forty years, these costs are projected to exceed those of all other chronic diseases.
"When we discuss brain health and prevention, we're safeguarding our blueprint for the future. It's not merely about reacting; it's about actively cultivating a culture of prevention for neurological diseases," said Prof. Wolfgang Grisold, President of WFN. "Our dedication to preventing neurological disorders is the cornerstone of our resilience for tomorrow."
According to CHeBA's Co-Directors, there is now enough evidence that many lifestyle changes can reduce the risk of dementia by 40% or more, which is what makes Maintain Your Brain such a significant research trial.
Through the Maintain Your Brain trial, researchers from CHeBA gave half the study participants information on up to four areas - physical activity, nutrition and diet, brain activity and mental health, and the other half received personalised online coaching in those areas.
Preliminary results have demonstrated the greatest benefit to date in prevention of cognitive decline, especially for those who received personalised coaching.
The Maintain Your Brain model is an intervention that is scalable for broad use. Significant funding is needed to implement an enhanced version of the Maintain Your Brain online intervention to a wider population reaching a greater diversity of Australians. This would then lead to consideration of application for a patent and discussions with federal government for national delivery, health funds or technology companies for commercialisation.
On a societal level, these interventions could result in significant impacts on worldwide prevalence.
This research will have an enormous impact on the future of Alzheimer's disease and other dementias.
Ita Buttrose AC OBE
Chair, CHeBA Advisory Committee
Patron, Maintain Your Brain
